Provider Demographics
NPI:1720278278
Name:FAMILY HEALTH CARE OF SIOUXLAND LLC
Entity Type:Organization
Organization Name:FAMILY HEALTH CARE OF SIOUXLAND LLC
Other - Org Name:FAMILY HEALTH CARE MOVILLE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHANIN
Authorized Official - Middle Name:C
Authorized Official - Last Name:MCCABE-HARDING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-226-2600
Mailing Address - Street 1:814 PIERCE ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51101-1058
Mailing Address - Country:US
Mailing Address - Phone:712-226-2600
Mailing Address - Fax:712-226-2605
Practice Address - Street 1:410 MAIN ST
Practice Address - Street 2:
Practice Address - City:MOVILLE
Practice Address - State:IA
Practice Address - Zip Code:51039-7715
Practice Address - Country:US
Practice Address - Phone:712-873-5225
Practice Address - Fax:712-873-5206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-31
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA163890OtherMEDICARE RIVERBEND GOVERN
IA0263913Medicaid